Alexandra McKinty will not be putting her 13-month-old in line for the swine flu vaccine. Madelyn, she says, has already had too many shots in her short life. And Loretta Jergensen of Parkville is worried that the vaccine wasn't adequately tested, so her two children also will probably pass.

The two mothers illustrate the problem public health officials are having despite an all-out offensive - including an appearance Friday by U.S. Secretary of Health and Human Services Kathleen Sebelius at a Prince George's County school. She and others are trying to convince parents that the new H1N1 vaccine is safe and effective. Some parents are still too confused, afraid or indifferent to get vaccines for their children: A new Associated Press poll showed that more than a third of parents don't want their children vaccinated.

As her daughter played at the Patterson Park playground, McKinty said she is not concerned about the child getting swine flu. But she is concerned about the vaccine. "At this age, they get so many vaccines like MMR [measles-mumps-rubella] and others that I don't want another one. This came on so fast that they can't have tested it for more than a year, and they don't know the long-term effects."

During the vaccinations of about 78 children at Dodge Park Elementary School on Friday, Sebelius said that, as a parent, she understood the "reluctance to experiment on one's children. But while this virus strain has not been seen before, the vaccine process is the same as we have used for the seasonal flu vaccine. There are clinical trials showing it is safe and effective with no adverse reactions."

Officials from local hospitals and health departments have been holding news conferences for the past week in an effort to get their message out and stem what already has become a pandemic.

Many parents are responding, including Amy MacDonald and her husband, Alan, of Annapolis. A few weeks ago their sons Ian, 8, and Scatt, 12, came down with flulike symptoms. Tests showed they didn't have swine flu, but the parents have learned that the H1N1 flu disproportionately affects kids and has killed two Baltimore-area children. Because the boys didn't test positive for H1N1, they came to one of the first Anne Arundel County clinics for a vaccine. Christopher, 11, who hadn't been sick, got one, too.

"I would strongly encourage getting the vaccine after having lived through this," said Amy MacDonald.

The Anne Arundel County Health Department had 450 appointments within a few hours into its two-day clinic for people in target groups for early vaccination, including children, health care workers and those caring for infants. That was a good showing for a last-minute event, said Dr. Edward Van Oeveren, the county's health officer.

Lucyna Obrebski, whose son David was playing at the same playground as McKinty's daughter, represents some of the reluctance area mothers feel. She said she, too, is worried about the flu. But she's also worried about the vaccine's effects. Her sister was vaccinated for seasonal flu last year and was sick for four months afterward, though Obrebski said she wasn't sure the illness was linked to the shot.

"I'm confused," she said. "The doctor recommended [David] get it, but he doesn't have it [available]. Maybe we'll go next week."

Jergensen, the Parkville mother, said she's pretty firmly against the H1N1 vaccine. She has already planned to get the seasonal flu vaccine for her daughters, 5-year-old Emaline and 9-month-old Ruby. But she's probably not going to get the swine flu vaccine.

She's not quick to believe rumors on the Internet about potential ill effects of thimerosal, a mercury-based preservative that will be in some injectable versions of the vaccine. Some believe it is linked to autism, though health authorities say the evidence is not there. For those parents who still would like to avoid thimerosal, authorities say they should ask for single-dose vaccine or the nasal spray, which is made without it.

"My pediatrician said she's getting her children vaccinated, and you would think that would be a ringing endorsement," Jergensen said. "I'm still in the camp where I don't think there is good enough research and testing. Maybe next year, I'll be more open. I'm taking the wait-and-see approach."

So far, there have not been widespread reports of ill effects. But the nasal spray version just became available in limited quantities this week at local health departments, pediatricians' offices and hospitals. Because it's made of live virus, it can't be taken by children under 2, pregnant women or those with underlying health problems. An injectable version is expected out next week. The first targets for the nasal spray are young people ages 2-24, those who care for infants who can't be vaccinated and health care workers.

Kids under 10 will need two doses of the vaccine, and those who get the spray version can't have the spray version of the seasonal flu vaccine for four weeks. Shots can be given together.

Unlike seasonal flu, which is anticipated every year, the H1N1 flu surfaced unexpectedly in April, waned and made a comeback in September when school started. That had the manufacture of vaccine ramping up late. It's being shipped as it is produced and tested, so supplies remain limited. That has meant school-based clinics have had to wait. State health officials expect most of them to begin in late October or November - local health departments say they will post information on their Web sites about where and when the vaccine will be available.

During one of the recent news conferences with those on the front lines, doctors sought to explain the importance of lining up as soon as vaccines become available.

"We understand that parents and individuals have concerns," said Dr. Aaron Milstone, a pediatric infectious disease specialist at the Johns Hopkins Children's Center and an assistant professor at the Johns Hopkins University School of Medicine. "We're hoping to reassure people and provide guidance."

The guidance includes what to do if parents believe their child is sick. Symptoms include headache, sore throat, body aches, extreme fatigue, coughing, sneezing, vomiting and diarrhea, according to the Johns Hopkins Children's Center. Most patients recover in three to five days and do not require hospitalization.

Doctors from University of Maryland Hospital for Children and Johns Hopkins Children's Center say they have seen a large upswing in the number of children coming in with the usual flu symptoms. The doctors recommended, however, that most children stay home to stop the spread of disease.

They advise treating flu symptoms with Tylenol or Advil and lots of fluids. Medical attention should be sought if the child has other medical conditions, trouble breathing, bluish or grayish skin color, trouble waking up, a rash or worsening symptoms.

But if they do not specifically test positive for H1N1, children who have been ill - like the MacDonald children - still need to be vaccinated.

"We've seen two times the normal numbers in the emergency room," said Dr. Mitch Goldstein, a specialist in emergency medicine at the Johns Hopkins Children's Center and an assistant professor at the Johns Hopkins University School of Medicine. "Most don't have severe illness, but they have worried family members."

Meanwhile, parents of children whose classmates are ill should not keep their healthy kids home - something that may be tough for some to accept since the death of 14-year-old Destinee Parker, who attended Montebello Elementary/Middle School.

Anne Bailowitz, Baltimore's acting chief medical officer, said the schools have all been instructed to take the same measures whether they have sick kids or not. They should keep soap, towels and sanitizer available. They should regularly clean common surfaces. Scrubbing down schools or closing schools isn't necessary and "the basics work well." She added that the health department has begun spot-checking schools for compliance.

Flu information
For more information about preventing or treating the flu, go to flu.maryland.gov. The site will also offer information on vaccines once they're available, as will local health department sites.